CDC Resources for Smallpox
Smallpox Information for Specific Groups
Vaccinia (Smallpox) Vaccine Recommendations
FORMS AND DOCUMENTATION
Biological Order and Transfer Form (C-68) (76KB)—Used to order and transfer vaccine. Used as needed by clinics and depots.
Texas DSHS Monthly Biological Report (C-33A)—Used to record vaccine inventory by lot number for each storage site or depot. Submitted monthly to BIP.
Texas DSHS Daily Tally Sheet (C-88) (19KB)—Used to record doses administered by age for each clinic site. Submitted after completion of clinic to centralized supply depot or immunization program.
Texas DSHS Doses Administered (C-5) (11KB)—Used to report doses administered by age for jurisdiction or public health region. Submitted monthly to BIP.
To order or print TDH forms go to: http://www.tdh.state.tx.us/immunize/doseform.htm
TDH Personal Immunization Records (C-102 and C-100 for child; C-104 for adults)—Client's personal record of vaccines they received at clinics.
VAERS (Vaccine Adverse Event Reporting System) Form (20KB)
Clinic Registration Sheet (8KB)
Screening Tool for Smallpox
Top of Page